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[11 <br /> �°� SEPTIC SYSTEM APPROVAL q " � <br /> Street Address: Mailing Address: Telephone: (952)249-4600 <br /> e 2750 Kelley Parkway PO Box 66 Fax: (952)249-4616 <br /> 4kB5Hov- Orono, MN 55356 Crystal Bay, MN 55323 www.ci.orono.mn.us <br /> Address: ` �,5- ^'R. v t w 0.t. Home Phone: <br /> Owner: f 1 l9 fr. <br /> /Al yr i l' Work Phone: <br /> Site Evaluator: /�t� /y U CP//-,,A> State License# 3/a <br /> Site Evaluator Phone Number: 7`3 -4/98-$ 77? <br /> Garbage Disposal? Yes No Number of bedrooms: 5" Est. gallons per day: 756 <br /> Water meter required? Yes Notes: <br /> TYPE OF TREATMENT SYSTEM <br /> s. . 2y. : AO c)w� <br /> k. .•I• Gravity trenches system: <br /> Pressurized trench system: Gravity trenches with lift: <br /> Pressurized bed system: Holding tank with alarm: <br /> Number of tanks: N Septic Tank Sizes: t /2©0 <br /> Lift tank size: /" /'3m© Pump brand: GPM: .UP Head: of 3• I. <br /> TREATMENT SYSTEM <br /> Minimum: 6 3o square feet with 9 inches of rock below pipe <br /> i ype of covering: Fabric: t Other: <br /> SEPTIC HISTORY <br /> Compliance Report attached? YES Nonce_ <br /> City as-built on file attached? YES No, explain N£e.so &we— <br /> SITE EVALUATION <br /> YES NO N/A <br /> Soils borings. <br /> At least three soil borings shall be completed for each new drainfield site designed. Each soil boring must be <br /> located within the drainfield site or within close proximity along similar contours such that similar soil conditions are <br /> likely. <br /> For additions to an ISTS,at least one soil boring shall be made in the expansion area. <br /> Percolation tests <br /> At least two percolation tests shall be completed for each new drainfield site designed. Each percolation test must <br /> be located within the drainfield site or within close proximity along similar contours such that similar soil conditions <br /> are likely. <br /> For additions to existing ISTSs,at least one percolation test shall be completed in the expansion area. <br /> Plot Plan. A scale drawing of the entire lot showing the following: <br /> All property lines and lot dimensions <br /> All existing and proposed structures <br /> All existing or proposed well locations or water supply piping <br /> Relative elevations of house, lot corners and drainfield areas <br /> Slope of ground at drainfield sites by contour lines or direction arrows and slope percentages <br /> Location of all percolation test holes and soil borings with identifying symbols and relative ground elevations of <br /> each <br /> Primary and alternate drainfield areas identified <br /> Distance from primary and alternate drainfield areas to property lines,well locations and any lake,stream,march <br /> or drainage channel within 75 of any part of the septic system. <br /> w:lsepticlseptic system approval revised 2-2015.docx <br /> Page 1 of 2 <br />